Thursday, January 1, 2009

An American Treatment for the 'American Nervousness': George Miller Beard and General Electrization

George Miller Beard won his place in American psychiatry through his promotion of neurasthenia as a nervous disorder. Understood vaguely as an inadequate endowment of nerve force to meet the demands of advanced civilization, this so-called disease was diagnosed in patients with a vast array of complaints including fatigue, “nervousness,” indigestion, headaches, impotence, and neuralgia. Efforts to understand how Beard arrived at this broad conception have focused on cultural and intellectual influences on his career as a neurologist.1 The role of his career as an electrotherapist in defining the concept of neurasthenia has not, however, been emphasized. 2

Beard began his medical career in 1866 as an electrotherapist and it was while developing the method he called “general electrization” that he drew together that vast array of symptoms under the label of neurasthenia. General electrization was, then, instrumental in the development of Beard’s conception of neurasthenia, which as he formulated it was virtually identical with the whole field of functional nervous disorders-- except for hysteria. As such this somatic therpy can be seen as playing a role in deliniating an area of investigation that would later be interpreted psychologically. The treatment itself, like animal magnetism, involved an elaborate ritual and a belief in a more or less mysterious fluid--in this case electricity. Whele derived from a popular American tradition of electrization, it, like neurastheia, was given an acceptable somatic explanation and became an established component of late nineteenth century neurological practice. In what follwos I will describe the development, contexst and influence of this treatment. George Miller Beard was born in 1839 in Connecticut, attended Yale, served in a non-specialist medical capacity during the civil war and received his medical degree from Columbia University in 1866. Ambitious, often bombastic and open to unorthodox ideas, he was a controversial figure during his life. Edward Spitzke, a highly regarded German trained neurologist, refered to him as the “P.T. Barnum of medicine” and in 1876 his paper 'The Influence of the Mind in the Causation and Cure of Disease and the Potency of Expectation' was severely criticized by his fellow neurologists. Beard’s interest in the medical application of electricity began while a student at Yale where he used it to obtain relief from persistent indigestion and nervousness--two complaints for which his patients would later also find it of value. In 1866, just out of medical school, he began a practice of electrotherapeutics with his friend A.D. Rockwell. Electrotherapy was then undergoing a revival. It had known a great vogue in the late eighteenth century; even Benjamin Franklin had tried it, though without much success. In the early nineteenth century, partly due to an association with animal magnetism and partly due to unreliable techniques, it had fallen into some disrepute and had been practiced largely by popular healers and quacks. Beginning in 1849 in Europe, Duchenne, Remak and a number of other prominent neuroloists had been perfecting a means of applying electric current to neuralgias, paralyses and other local affections. This 'local electrization' allowed for the more precise study of the effects of the electrical current and avoided undesirable systemic effects. it was these developments which had returned the attention of the established medical community to the healing possibilities of electricity and created the revival that Beard and Rockwell joined. By the civil war this European work had begun to enter the United States. In 1858 Garratt, reporting on travels to the continent, presented these recent developments in an enormous and somewhat forbidding manual. By 1869 there was sufficient interest for William A. Hammond to translate a major German work. Nonetheless in the United States as in Europe popular electrotherapists had continued to practice largely uninfluenced by the work of Duchenne and the others. One of these was William Miller. A man of seventy at the end of the civil war, he had been practicing electrotherapy for thirty five years. In 1866 he befriended Beard and Rockwell and was under his influence that they began their electrotherapy practice. Called doctor only by courtesy, Miller had developed a thriving practice in New York City. Impressed by his 'evident honesty,' and good results, Beard and Rockwell found him to be a 'thorough master of the method he invariably used.' It is reasonable to assume that they were heavily influenced by him. During the next two years as they developed their method of general electrization they practiced in the same building as Miller and treated a steady stream of patients sent by him. While we know nothing of Miller’s ideas and little of his practice, other American electrotherapists did publish during the period before the civil war. Common to these writers was an idea of nervous fluid and electricity as virtually identical, both often associated with a principle of vitality. Disease was often seen as due to a lack or disequilibrium of nerve force, and electricity was seen as restoring the healthy state. Since both mesmerism and electrization were regarded by some as due to similar if not identical fluids, it is not surprising to find one author who prescribes them interchangeably and another who bases his electrotherapy practice on a version of animal magnetism known as electrobiology. In any event, the hallmark of pre-civil war practice was the wide variety of conditions to which electricity was applied. Among the conditions for which good results were reported were: paralysis, rheumatism, asthma, indigestion, liver complaints, sciatica, nervous complaints and nervous headaches. Beard and Rockwell’s general electrization undoubtedly owes something to this earlier electrothrapeutics. In the first place, simply getting referrals from Miller exposed them to the same variety of complaints that Miller treated. In addition, they went “again and again” to study his method. The rationale of their treatment in terms of nerve tonic bears a clear resemblance to earlier notions of the relationship of nerve force, electricity and vitality. The aim of general electrization also resembled the earlier electrotherapeutics rather than the recent European practice. This aim was to “bring every portion of the body under the influence of the electric current.” The treatment itself involved an elaborate ritual. Patients would come to the doctor’s office for ten to twenty minute sessions. They would sit facing a more or less imposing generator. Both men and women would disrobe except for underclothing which would be loosened in such a way that free access could be had to the entire surface of the body. The cathode was placed under the coccyx or under the feet and the positive pole in the form of a damp sponge or the operator’s hand was moved over the head, neck, shoulders, trunk, extremities and, in the case of impotence, the penis as well. Interestingly, Beard and Rockwell recommended passing the current through the operator;s hand. This though criticized by Garrat, had been Miller’s technique for thirty-five years. As the treatment might be painful and as many of their patients were highly sensitive, having the current pass through the operator’s body allowed for the kind of individualized treatment that Beard and Rockwell regarded as critical. For example, with especially sensitive patients, the treatment might begin with the application of the doctor’s hands but no current at all. This would allow the doctor a palapable reading of the patient’s response to the idea of the treatment. In any event this individualized and highly intimate treatment proceedure, once begun, would be repeated daily or at least every other day for months. One of Beard’s cases, reported in 1866, three years before he first used the term neurasthenia, will suggest the kind of patient they treated and the way this treatment influenced theirperception of patients:A pale-lipped, sad-eyed lady came panting into our office and almost fell down in the sette before she could begin to tell her story. So exhausted was she with the exertion of ascending one flight of stairs, that her speech was at first only in broken utterances, and we very naturally surmised that she was laboring under some organic derangement of the heart. But the history of the case seemed to point unmistakably toward anoemia as the prime source of all her unpleasant symptoms. She was troubled with great depression of spirits, Amenorrhea had existed for nine months. The patient was so hysterical that the first application was given with difficulty. She could endure but the slightest current. Whenever its strength was much increased faintness was at once produced. This extreme susceptibity was, however, speedily overcome, and after the first week, she could bear a current of ordinary severity without the slightest discomfort. Applications were made every other day for a month, at the end of which time the improvement was most satisfactory. The menses returned after seven or eight applications. A few days ago she came briskly up the stairs, and with a light elastic step, and with a smiling rubicund countenance. All her cardiac symptoms had disappeared, her breating was natural, and her whole appearance was that of a person in the hey-day of youthful vigor. In the late 1860s, while developing general electrization, Beard and Rockwell began a campaign to promote and legitimize the treatment. It was a good time to promote a new treatment such as theirs. Neurology as a medical specialty was being born in America and its practitioners, like Beard and Rockwell, worked not in asylums but in private ofices among the urban “comfortable classes.” Here they saw, and were to a certain extent in competition for, patients with vague and often chronic complaints of the sort that general electrization was designed to treat. That there was a need to legitimize the treatment can be seen in the fact that Rockwell was refused an opportunity to address the New York Medical Society on the grounds that electrotherapy was advocated only by quacks. Beard and Rockwell pursued this campaign in a series of papers some of which were republished as a book and then expanded into the impressive looking Practical Treatise on the Medical and Surgical Uses of Electricity. With some lack of gratitude their first objective was to distinguish themselves from such irregular parctitioners as Miller. In these papers Miller is referred to with respect, but only incidentally. Of other American electrotherapists they wrote: In our country at least the practical applications of this agent [electricity] has fallen into the hands of uneducated and unscrupulous practitioners who know little of the human sysyem and still less of the agent they employ. Empirics and charalatans versed in no art except that of robbing the unfortunate have thus far had the field mostly to themselves… Garratt, whose cautious and practical book had reported on twenty years of experience as well as introducing European work, was dismissed as 'verbose and mystic.' Such rhetorical excess must have been intended to convince their readers that they were rescuing the field for scientific medicine. An equally important objective of this campaign was to identify themselves with the European tradition associated with Duchenne and Remak, while claiming their own work as a genuine innovation. The very name of their treatment, general electrization, would have called to mind Duchenne’s local electrization. Comparing the tow they wrote that, “ While it is true, as is commonly supposed that galvanism and faradization are specially indicated in certain forms of paralysis it is also true that they are still morevaluable in general nervous debility whether it manifests itself in the shape of dyspepsia, chorea, neuralgia, anemia or amenorrhea.” In another place they add that parealysis is among the “least tractible of the various diseases that present for…” electrization. At the same time they promoted their discovery that electrization, used generally, “is a tonic of vast and varied powers.” Others had failed to perceive this tonic property of the curent because they had either applied it only locally or had failed to persist in its application in the face of discouragement. Readers were, it seems, to see their treatment as a logical thouugh original extension of accepted electrotherapeutic practice. In 1869 Beard published 'Neurasthenia or Nervous Exhaustion' in the Boston Medical and Surgical Journal. While this paper is well known as his first use of a term which would have wide influence on late nineteenth century neurology, it can be seen in the context of his career as an electrotherapist as his most effective effort to popularize and legitimize his treatment. He indicated here that his “atention was first drawn to this morbid condition quite early in [his] professional life in the cultivation of the department of neurology and electrotherapeutics…” Although the expressed intent of this paper was merely to coin a name for a commonly observed phenomenon, what it did in effect was to attribute the array of symptoms for which general electrization worked so well to a single neurological disease-- neurasthenia. Much of the paper was devoted to praising the treatment and it recorded that twenty out of thirty ofBeard’s neurasthenics were either cured or much improved by it. As a disease due to a want of nerve force neurasthenia was suitabley treated by nerve tonics and Beard concluded that, among those tonics, general electrization was “preeminent.” For Beard as an electrotherapist this identification of his treatment with such a disease could only have helped distinguish him from empirics and charalatans. During the next few years Beard and Rockwell changed the name of their original proceedure, which involved induced current, to general faradization. They also developed a new proceedure, central galvanization, in which direct current was applied primarily to the head and spine. Beard increasingly identified with the rising specialty of neurology; he sold his share of their electrotherapy treatise to Rockwell and devoted his energies to writing about neurasthenia, or as he came to call it the “American Nervousness.” As a neurologist he continued to use general electrization and to encourage others to do so. It becam, however, only one of many treatments in a complicated gegimen and this has tended to obscure its unique role in the deliniation of the concept of neurasthenia. The reaction to general electrization itself was ambivalent, though most of the negative reaction appears to have been to Beard and Rockwell’s style, rather than to the treatment itself. A review in 1868 suggestd that Beard and Rockwell had been less than scientific, doubted that their claims were warranted and referred the reader to a translation of a French report in the same issue. That some change in attitude may have occured is suggested by the fact that Rockwell, though interestingly not Beard, was a charter member of the American Neurological Association and presented a paper on electrization at its first meeting 1875. What influence their Practical Treatise, which appeared in 1871, had on this is hard to say. Certainly its form resempled European treatises, even if it continued to be, in large measure, an advertisement for their version of electrization. Nonetheless it was translated into German and ten additions appeared over the next forty years. In 1876 the Journal of Nervous and Mental Diseases, the official journal of the American Neurological Association, devoted a long review to the second edition of ther treatise. It did not question the rationale, method or results of the treatment, though it did look askance at the authors denigration of experimental science and worried that their enthusiastic promotion of electrotherapy might lead to sectarianism In germany personal reactions to the authors were apparently less important. Fischer reported good results with their method and maintained that constitutional illnesses like 'nervous dyspepsia, neurasthenia, anemia, chlorosis, hypochondria and hysteria' should be treated with general electrization while local diseases werre indications for local electrical treatment. Erb, in a text that Freud among others used, credits Beard and Rockwell with the development of general electrization and notes that he also got good results with it. The reaction of patients is more difficult to determine except through the fact that the treatment remained popular for many years. One case cited by Beard does suggest the role that belief in the tonic properties of electricity as well as his charisma played in the treatment.

The patient was a twenty-nine year old physician who was chronically underweight and suffered and sick headaches, fatigue, poor appetite. After the first treatment he felt temporarily enlivened and exhilarated… returning after two days he felt no special benefit, but had gained one half pound. This change, however slight as it was, encouraged him. He watched and studied his symptoms, and carefully ascertained his weight from day to day, not as a hypochondriac at all, but as a scientific man, inspired not by any special faith in the remedy but by a desire to test for himself the tonic effects of general electrization. He continued to gain weight…The improvement in his general condition has gone hand in hand with [this].

Whatever the reaction to Beard and Rockwell’s often bombastic style the treatment became standard for functional nervous disorders. This is not surprising in that they had effectively camoflaged any associations between their treatment and early nineteenth century electrotherapeutics and, in presenting the treatment as a nerve tonic had used a somatic vocabulary acceptable to doctors and patients. In addition it is reasonable to assume that general electrization was helpful to many nervous patients. One sign of the treatment’s acceptance was its role in S. Weir Mitchell’s rest cure. In 1876 Mitchell gave as the pillars of his treatment isolation from family, strict bed rest, overfeeding, massage and electrization. He cited Beard and Rockwell and considered electrization a tonic--albeit for muscles. As a component of the rest cure general electrization was assured an even wider acceptance, though not as the preminent treatment for neurasthenia that Beard had once claimed it to be. Serious doubts about electrization did not begin to appear until the 1890s. After Beard’s death in 1883, Rockwell continued reediting and republishing their treatise until 1903, maintaining throughout that electrization worked as a tonic. Moses Allen Starr, a somatically oriented neurologist, did not question the rationale of the treatment but in 1892 reported that he found its results disappointing. In 1889 Moebius in Germany wondered if the success of electrotherapeutics was due to ‘’suggestion’’ initiated by the elaborate apparatus, the mysterious nature of the treatment and the stimulation of the faith of the patient. In 1895 Freud referred to electrization as a 'pretense treatment' and gave a perceptive psychological rendering of Elizabeth von R’s response saying that she 'took a liking to the painful shocks' and that 'the stronger these were the more they seemed to push her own pains into the background.' Even J.J. Putnam, who had been critical of Beard’s psychological approach in 1876, wondered if electrization, whil still useful in treating neurasthenia, didn’t act by suggestion. General electrization then, only began to lose ground with the somatic model which had supported it. It survived into the twentieth century only where the somatic approach to functional nervous disorders persisted and cannot be seen as a forerunner to any psychotherapy. Nonetheless during its brief preeminence as a nerve tonic it focused George Miller Beard’s attention on that cluster of symptoms that he called neurasthenia. In doing so, like animal magnetism, it pointed to an area of investigation which would be interpreted psychologically.

Presented to the American Association of the History of Medicine, Boston 1980